Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.
-
Upload
patrick-thomas -
Category
Documents
-
view
214 -
download
0
Transcript of Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.
![Page 1: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/1.jpg)
Bakhshaee M, MDRhinologistAssistant Professor of Mashad University of Medical Sciences
![Page 2: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/2.jpg)
Four sessions:
1. Anatomy, Physiology, and Immunology of the Nose, Paranasal Sinuses, and Face
2. History and Clinical Examination of the Nose; Tumors of the External Nose and Face
3. Malformations and common disorders of the Nose, Paranasal Sinuses, and Face
4. Inflammations of the External Nose, Nasal Cavity, and Facial Soft Tissues
Estimated time for each session is 100 min
![Page 3: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/3.jpg)
Including:
1.Initial assessment: 10 min2.Lesson delivery: 60 min3.Discussion: 15 min4.Question and problems of previous
session: 10 min5.A brief talking on next session: 5
min
![Page 4: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/4.jpg)
Anatomy, Physiology, and Immunology of the Nose, Paranasal Sinuses, and Face
![Page 5: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/5.jpg)
Basic Anatomy of the Nose, Paranasal Sinuses, and Face
Morphology of the Nasal Mucosa
Basic Physiology and Immunology of the Nose
![Page 6: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/6.jpg)
•The relaxed skin tension lines (RSTLs): Scars can be made less conspicuous by taking these tension lines into account
•The aesthetic units of the face: an important consideration in the treatment larger soft-tissue defects
![Page 7: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/7.jpg)
Knowing the various components of the bony facialskeleton and their relationship to one anotheris important in trauma management and also inthe diagnosis and treatment o inflammatory diseasesof the facial skeleton and their complications.
![Page 8: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/8.jpg)
![Page 9: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/9.jpg)
Nasal VestibuleNasal SeptumNasal ValveLateral nasal WallChoana
![Page 10: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/10.jpg)
Bony Structure:
1.Maxilla2.Ethmoid3.Palatine4.Inferior Turbinate5.Sphenoid
Functional apparatus:
1.Turbinate 2.Meatus3.Sinus ostia4.Nasolacrimal duct orifice
![Page 11: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/11.jpg)
Roof:
1.Cribriform palate2.Ethmoid fovea
Floor:
Hard palate1.Maxilla (Ant)2.Palatine (Pos)
![Page 12: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/12.jpg)
Air-filled cavities that communicate with the nasal cavities
All but the sphenoid sinus are present as outpunching of the mucosa during embryonic life, but except for the ethmoid air cells, they do not develop into bony cavities until after birth.
![Page 13: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/13.jpg)
Medial: Lateral nasal
wall
Superior: Orbital floor
Posterior: Pterygopalatine fossa
Inferior: Alveolar ridge
( root of second premolar and first molar)
![Page 14: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/14.jpg)
Medial: Middle turbinate
Superior: Fovea
ethmoidalis ( Ant cranial fossa)
Posterior: Sphenoid sinus
Lateral: Lamina
papyruses ( orbit)
![Page 15: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/15.jpg)
Inferior: Nasopharynx
Superior: Ant and middle
cranial fossa , Sellae tursica
Posterior: Clivus and
posterior cranial fossa
Lateral: Optic nerve Internal carotid Cavernous sinus
![Page 16: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/16.jpg)
Inferior: Orbital roof
Posterior: Anterior cranial fossa
![Page 17: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/17.jpg)
![Page 18: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/18.jpg)
Innervation
![Page 19: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/19.jpg)
Muscular attachments
![Page 20: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/20.jpg)
![Page 21: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/21.jpg)
Mucus:Squamous epitheliumRespiratory MucosaOlfactory Mucosa
Respiratory Mucosa:1.Epithelium2.Lamina Properia:Venous erectile tissueNasal glandsImmunocompetent cells
Olfactory Mucosa:primary olfactory center( olfactory bulb)secondary olfactory center (olfactory cortex)tertiary olfactory centers (including the hippocampus,anterior insular region, and reticular formation)
![Page 22: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/22.jpg)
Nose is of major importance in conditioningthe air before it reaches the lower airways
![Page 23: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/23.jpg)
Nasal Air FlowLaminar vs Turbulent
Nasal CycleRegulate by autonomic nervous system80% of human each 2 hours
![Page 24: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/24.jpg)
Humidification
Temperature regulation
![Page 25: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/25.jpg)
Nonspecific Defense Mechanisms1.Mechanical defenses (mucociliary apparatus) 2. Nonspecific protective factors (Interferon, Proteases, Protease inhibitors , Lysozyme Antioxidants)3.Cellular defenses (phagocytic cells)
Specific Immune Responses1.Humoral immune response2.Cellular immune response3.The endothelial cells4.The epithelial cells
![Page 26: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/26.jpg)
Various organ systems are involved in the production of voice and speech:
Glottis, Supraglottic vocal tract, Central nervous system must be coordinated in order to produce a normal voice sound
Hyponasal speech (rhinophonia clausa) : occurs when these segments contribute less to sound production as a result of partial or complete nasal obstruction or mass lesions in the nasopharynx
Hypernasal speech (rhinophonia aperta): develops when the nasopharynx
and nasal cavities over contribute to sound production. cleft palate, velar palsy due to various causes
![Page 27: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/27.jpg)
The human olfactory system consists of
1. Intranasal olfactory mucosa 2. Primary olfactory center 3. Secondary olfactory center 4. Tertiary olfactory center
The precise sequence of events that are involved in olfaction is still uncertain.
![Page 28: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/28.jpg)
1. Name the main the nasal septum structure.
2. Name the functions of the nose?
3. The major artery of the nose is ….
4. Sphenoid sinus is drained to ….5. Orbital cellulitis is seen often
due to … sinus involvement.
![Page 29: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/29.jpg)
History and Clinical Examination of the Nose; Tumors of the External Nose and Face
![Page 30: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/30.jpg)
Patients should be given an opportunity to describe their complaints “in their own words,”
![Page 31: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/31.jpg)
Nasal obstructionDischargeEpistaxisSpecific allergy historyHeadachesOlfactory dysfunctionFacial pressure or pain
![Page 32: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/32.jpg)
Acute and chronic rhinitis (e.g., allergic, atrophic)1. • Sinusitis2. • Deviated septum (congenital, acquired)3. • Nasal pyramid fracture4. • Septal perforation5. • Nasal polyps6. • Cephalocele7. • Adenoids8. • Tumors of the nose, paranasal sinuses, and nasopharynx9. • Foreign bodies (especially in small children)10.• Drugs
Adverse effects: oral contraceptives, antihypertensive agents (e.g., reserpine, propranolol, hydralazine), antidepressants (e.g., amitriptyline)
Drug abuse: e.g., oxymetazoline , phenylephrine
![Page 33: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/33.jpg)
Transport of odorants1. Nasal obstruction Deviated
septum, mucosal2. swelling, polyps, tumor3. Scar tissue occluding the
olfactory groove4. After intranasal surgery Perception: damage to
the olfactory epithelium caused by:
1. Toxic substances SO2, NO, ozone,
2. Heavy metals, varnishes3. Drugs4. Viral infections Influenza5. Radiotherapy (rare)
Stimulus conduction and processing
1. Avulsion of fila olfactoria Skull base fracture
2. Aplasia of the olfactory bulb (rare)
3. Kallmann syndrome4. Injury to olfactory centers 5. Contusion or hemorrhage due to
head injury6. Neurodegenerative diseases7. Alzheimer disease,8. Parkinson disease,9. Diabetes mellitus10. Olfactory hallucinations after
epileptic seizures, in schizophrenia
![Page 34: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/34.jpg)
Inspection
1.Mouth breathing2.Shape of the external nose3.Skin changes such as erythema
![Page 35: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/35.jpg)
Palpation
Useful for detecting bony discontinuities
In patients with suspected neuralgias
![Page 36: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/36.jpg)
To evaluate the nasal vestibule and the anterior portions of the nasal cavity
![Page 37: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/37.jpg)
Posterior rhinoscopy was formerly done to evaluate the nasopharynx and posterior nasal cavity (choanae, posterior ends of the turbinates, posterior margin of the vomer)
Endoscopy is commonly used to examine this region
![Page 38: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/38.jpg)
Nasal endoscopy has become the most important and rewarding clinical examination method in rhinologic diagnosis
![Page 39: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/39.jpg)
First the examiner advances the endoscope into the nasopharynx and inspects:
Eustachian tube orifice Torus tubarius Posterior pharyngeal wall Roof of the nasopharynx
![Page 40: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/40.jpg)
Nasal endoscopy is particularly useful for evaluating the ostiomeatal unit
![Page 41: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/41.jpg)
![Page 42: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/42.jpg)
Nasal Patency:
Hold a reflective metal plate under the nose
Holding a wisp of cotton in front of each nostril
Active anterior rhinomanometryAcoustic rhinometry
![Page 43: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/43.jpg)
Skin Tests
The total immunoglobulin E (IgE) assay
Nasal provocation test
![Page 44: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/44.jpg)
The total immunoglobulin E (IgE) assay
![Page 45: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/45.jpg)
Several types of test substance are used:
1. Pure odorants that stimulate only the olfactory nerve (coffee, cocoa, vanilla, cinnamon, lavender)
2. Odorants with a trigeminal component (menthol, acetic acid, formalin)
3. Substances that also have a taste component (chloroform, pyridine).
Patients with a complete loss of smell (anosmia) cannot perceive pure odorants but can at least sense or taste the other substances.
![Page 46: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/46.jpg)
Objective olfactory testing is far more costly and is generally performed only at large centers
![Page 47: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/47.jpg)
Conventional RadiographsComputed Tomography (CT)Magnetic Resonance ImagingUltrasonography
![Page 48: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/48.jpg)
Limited indication these days
![Page 49: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/49.jpg)
Water projectionCaldwell
Acute inflammationTo evaluate midfacial
fractures
![Page 50: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/50.jpg)
WATERS CALDWELL
![Page 51: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/51.jpg)
If there is a high index of suspicion for sphenoid sinus involvement, a lateral sinus projection should be added to the study
The craniocaudal extent of the frontal and maxillary sinuses can also be evaluated with this technique
![Page 52: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/52.jpg)
Indications
An occasional malformation, The main indications for CT scanning
of the nose and paranasal sinuses are 1.Chronic sinusitis 2.Trauma (especially frontobasal
fractures)3. Tumors
![Page 53: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/53.jpg)
![Page 54: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/54.jpg)
![Page 55: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/55.jpg)
The normal mucosal lining of the sinuses is not visualized.
The bony sinus walls appear hyperdense (white)
![Page 56: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/56.jpg)
![Page 57: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/57.jpg)
The strength of MRI lies in its superior soft-tissue discrimination
![Page 58: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/58.jpg)
Disorders that involve the paranasal sinuses in addition to the cranial cavity or orbit (e.g., tumors and congenital malformations such as encephaloceles)
It can also supply information that is useful in differentiating soft-tissue lesions within the paranasal sinuses (mucocele, cyst, polyp)
It can distinguish between solid tumor tissue and inflammatory perifocal reaction
![Page 59: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/59.jpg)
Patients with electrically controlled devices such as a cardiac pacemaker, insulin pump, cytostatic pump, or cochlear implant.
Modern internal fixation materials such as titanium are usually nonmagnetic and therefore MRI-compatible
![Page 60: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/60.jpg)
The paranasal sinuses can also be visualized with ultrasound.
The sphenoid sinus is inaccessible to ultrasound imaging because of its location.
![Page 61: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/61.jpg)
![Page 62: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/62.jpg)
1. Inverted Papilloma
2. Osteomas
![Page 63: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/63.jpg)
It is a locally aggressive tumor, and transformation to squamous cell carcinoma is periodically described
Symptoms and diagnosis: Nasal airway obstruction, headache, and
occasional epistaxis. The lesion often has a polyp-like appearance when
inspected by nasal endoscopy
Treatment: The treatment of choice is surgical removal
![Page 64: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/64.jpg)
Benign bone tumors that may occur as isolated masses, especially in the ethmoid cells and frontal sinus
Symptoms and diagnosis: Often they do not become symptomatic until they
obstruct drainage tracts to or from the paranasal sinuses, leading secondarily to headaches and recurrent bouts of sinusitis
Treatment: As soon as an osteoma becomes symptomatic, it
should be surgically removed
![Page 65: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/65.jpg)
Malignant tumors of the nasal cavity and paranasal sinuses are far more common than benign masses.
Histologically, the great majority (> 80%) are tumors of the epithelial series (e.g., squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma).
Neoplasms of mesenchymal origin, such as osteosarcomas and chondrosarcomas, as well as malignant lymphomas are much less common.
Metastases from other malignancies are occasionally found, with the primary tumor residing in the kidney, lung, breast, testis, or thyroid gland.
![Page 66: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/66.jpg)
The main sites of predilection are the nasal cavity and maxillary sinus, followed by the ethmoid cells, frontal sinus, and sphenoid sinus.
![Page 67: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/67.jpg)
Because many tumors originate in the paranasal sinuses themselves, they often do not produce clinical manifestations until they have reached an advanced stage
![Page 68: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/68.jpg)
Obstructed nasal breathing Bloody rhinorrhea Fetid nasal odor Swelling of the buccal soft tissues Swelling at the medial canthus Headache, facial pain, and Hypoesthesia or numbness of the cheek Orbital infiltration can lead to displacement
of the orbital contents, diplopia, or proptosis Trismous Epiphorea Dental loosening
![Page 69: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/69.jpg)
Unilateral sinusitis that is refractory to treatment
![Page 70: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/70.jpg)
The clinical examination includes
Endoscopic inspection of the nasal cavity
Search for regional lymph-node metastases by bimanual palpation of the cervical soft tissues.
![Page 71: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/71.jpg)
Since sinus tumors are apt to invade the nasal cavity secondarily, endoscopy alone may provide little information on the extent of the mass. For this reason, computed tomography and/or magnetic resonance imaging should always be performed
![Page 72: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/72.jpg)
![Page 73: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/73.jpg)
![Page 74: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/74.jpg)
is individualized according to the histology and extent of the malignant tumor, and the treatment plan should be coordinated with the radiotherapist and medical oncologist.
Since the great majority of lesions are
squamous cell carcinomas, however, the treatment of choice will usually consist of surgery and postoperative radiation
![Page 75: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/75.jpg)
Since only about 20% of sinonasal malignancies metastasize to regional lymph nodes, a neck dissection is necessary only in patients who have clinically positive cervical nodes
Many of these cases will require postoperative radiotherapy
![Page 76: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/76.jpg)
Is a rare neurogenic malignancy that arises from the sensory cells of the olfactory region and generally occurs in adults
Advanced, the tumor causes obstructed nasal breathing, recurrent epistaxis, and particularly hyposmia or anosmia.
Some of these tumors become symptomatic only after invading the cranial cavity or orbit, causing headache or visual deterioration
![Page 77: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/77.jpg)
is based on endoscopy and especially computed tomography or magnetic resonance imaging; only these modalities can accurately define the tumor extent
![Page 78: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/78.jpg)
Based on a combination of tumor resection and postoperative radiotherapy
![Page 79: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/79.jpg)
1. Name five more common sinonasal symptoms.
2. How you check the nasal patency?
3. What imaging modality is the best for sinonasal evaluation?
4. Name the common symptoms and signs of sinonasal tumor.
5. Which tumor is specific for the nasal cavity?
![Page 80: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/80.jpg)
Malformations of the Nose, Paranasal Sinuses,and Face
![Page 81: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/81.jpg)
Malformations involving the nose may be caused by developmental abnormalities of the nasal floor, palate, nasal roof, and intranasal region
![Page 82: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/82.jpg)
Incidence of one in 5000 to one in 10,000 births. More often unilateral than bilateral. The atresia is bony in 90% of cases and membranous in only 10%.
![Page 83: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/83.jpg)
Bilateral choanal atresia is an acutely life threatening emergency because the neonate, except when crying, is an obligate nasal breather until about the sixth week of life.
Cyanosis that is present at rest and improves with exertion is called paradoxical cyanosis because of its opposite pattern relative to cyanosis with a cardiac cause
![Page 84: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/84.jpg)
Unilateral choanal atresia may be manifested by a purulent nasal discharge on the affected side.
![Page 85: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/85.jpg)
Choanal atresia may be associated with various other anomalies:
CHARGE syndrome (coloboma; heart disease; atresia of the choanae; retarded growth, development and/or central nervous system anomalies; genital
hyperplasia; ear anomalies or deafness).
![Page 86: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/86.jpg)
The clinical suspicion of choanal atresia can be confirmed by examination with a rigid or flexible endoscope
![Page 87: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/87.jpg)
The acute care of choanal atresia in asphyxia consists of intubation followed by perforation of the atresia plate
The definitive surgical repair of bilateral choanal atresia is performed during the first weeks or months of life.
Surgery for unilateral atresia can be postponed until school age, when the anatomy of the region is more similar to that encountered in adults
![Page 88: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/88.jpg)
Incidence of dysraphias involving the anterior skull base is approximately one in 20,000 to one in 40,000 births
![Page 89: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/89.jpg)
Various manifestations that include:
1.Dorsal nasal fistulas 2.Dermoids 3.Frontonasal extracerebral gliomas4.Frontonasal extracerebral
cephaloceles
![Page 90: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/90.jpg)
A dorsal nasal fistula consists of a fistulous tract that is lined by keratinized squamous epithelium and forms a tiny opening on the dorsum or tip of the nose
![Page 91: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/91.jpg)
Fistulas that terminate blindly are usually manifested clinically at an older age due to inflammation around the fistulous opening.
If the fistula communicates with the subarachnoid space, it can lead to severe complications such as cerebrospinal fluid leakage, meningitis, or brain abscess
![Page 92: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/92.jpg)
The diagnosis is established by computed tomography or magnetic resonance imaging.
Diagnostic catheterization or contrast injection is contraindicated due to the risk of intracranial complications.
![Page 93: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/93.jpg)
Treatment consists of complete removal of the fistulous tract
![Page 94: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/94.jpg)
Cephaloceles are herniations of
intracranial contents through a bony
defect in the skull
![Page 95: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/95.jpg)
Most cephaloceles are congenital, but rare cases are post-traumatic
![Page 96: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/96.jpg)
Sincipital cephaloceles are located near the glabella, forehead or orbit.
Basal cephaloceles are found mainly in the nasal cavity or nasopharynx.
![Page 97: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/97.jpg)
Most are manifested clinically during childhood.
The sincipital forms appear as: a pulsating mass near the glabella, often associated with a broad nasal dorsum and hypertelorism
![Page 98: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/98.jpg)
Basal forms present as : an intranasal mass, typically with
associated nasal airway obstruction.
They closely resemble intranasal polyps and should be considered in the differential diagnosis of children with suspected nasal polyps, which are rare in this age group
![Page 99: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/99.jpg)
Computed tomography (CT) and magnetic resonance imaging (MRI)
![Page 100: Bakhshaee M, MD Rhinologist Assistant Professor of Mashad University of Medical Sciences.](https://reader037.fdocuments.net/reader037/viewer/2022110321/56649cfe5503460f949ce1a1/html5/thumbnails/100.jpg)
Always surgical and consists of removing the cephalocele and repairing the dural defect